Provider Demographics
NPI:1851859623
Name:RICHARDSON, SARAH IRENE (COTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:IRENE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9701
Mailing Address - Country:US
Mailing Address - Phone:816-807-0525
Mailing Address - Fax:
Practice Address - Street 1:600 NE MEADOWVIEW DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1983
Practice Address - Country:US
Practice Address - Phone:816-554-9866
Practice Address - Fax:816-554-9867
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019006677224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant